Provider Demographics
NPI:1093872988
Name:LYN, CAROLYN NAGEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:NAGEL
Last Name:LYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:DENISE
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19162 YACHT LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2124
Mailing Address - Country:US
Mailing Address - Phone:714-721-6356
Mailing Address - Fax:
Practice Address - Street 1:18582 BEACH BLVD STE 23A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2012
Practice Address - Country:US
Practice Address - Phone:714-964-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant